Cidade José Pedro, Souza-Dantas Vicente Cês, Mamfrim Rafaela Braga, Miranda Renata Carnevale, Caroli Henrique Tommasi, Oliveira Natália Almeida, Thompson Alessandra Figueiredo, Oliveira Gabriela E, Póvoa Pedro
Intensive Care Unit 4, Department of Intensive Care, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental - Lisbon, Portugal.
Instituto D'Or de Pesquisa e Ensino - Rio de Janeiro (RJ), Brazil.
Crit Care Sci. 2024 Sep 27;36:e20240236en. doi: 10.62675/2965-2774.20240236-en. eCollection 2024.
To elucidate the impact of lymphopenia on critical COVID-19 patient outcomes.
We conducted a multicenter prospective cohort study across five hospitals in Portugal and Brazil from 2020 to 2021. The study included adult patients admitted to the intensive care unit with SARS-CoV-2 pneumonia. Patients were categorized into two groups based on their lymphocyte counts within 48 hours of intensive care unit admission: the Lymphopenia Group (lymphocyte serum count < 1 × 109/L) and the Nonlymphopenia Group. Multivariate logistic regression, propensity score matching, Kaplan‒Meier survival curve analysis and Cox proportional hazards regression analysis were used.
A total of 912 patients were enrolled, with 191 (20.9%) in the Nonlymphopenia Group and 721 (79.1%) in the Lymphopenia Group. Lymphopenia patients displayed significantly elevated disease severity indices, including Sequential Organ Failure Assessment and Simplified Acute Physiology Score 3 scores, at intensive care unit admission (p = 0.001 and p < 0.001, respectively). Additionally, they presented heightened requirements for vasopressor support (p = 0.045) and prolonged intensive care unit and in-hospital stays (both p < 0.001). Multivariate logistic regression analysis after propensity score matching revealed a significant contribution of lymphopenia to mortality, with an odds ratio of 1,621 (95%CI: 1,275 - 2,048; p < 0.001). Interaction models revealed an increase of 8% in mortality for each decade of longevity in patients with concomitant lymphopenia. In the subanalysis utilizing three-group stratification, the Severe Lymphopenia Group had the highest mortality rate, not only in direct comparisons but also in Kaplan‒Meier survival analysis (log-rank test p = 0.0048).
Lymphopenia in COVID-19 patients is associated with increased disease severity and an increased risk of mortality, underscoring the need for prompt support for critically ill high-risk patients. These findings offer important insights into improving patient care strategies for COVID-19 patients.
阐明淋巴细胞减少对重症新型冠状病毒肺炎（COVID-19）患者预后的影响。
2020年至2021年，我们在葡萄牙和巴西的五家医院开展了一项多中心前瞻性队列研究。该研究纳入了因严重急性呼吸综合征冠状病毒2（SARS-CoV-2）肺炎入住重症监护病房的成年患者。根据患者入住重症监护病房后48小时内的淋巴细胞计数，将患者分为两组：淋巴细胞减少组（淋巴细胞血清计数<1×10⁹/L）和非淋巴细胞减少组。采用多变量逻辑回归、倾向得分匹配、Kaplan-Meier生存曲线分析和Cox比例风险回归分析。
共纳入912例患者，其中非淋巴细胞减少组191例（20.9%），淋巴细胞减少组721例（79.1%）。淋巴细胞减少的患者在入住重症监护病房时疾病严重程度指数显著升高，包括序贯器官衰竭评估和简化急性生理学评分3（SAPS 3）评分（分别为p = 0.001和p < 0.001）。此外，他们对血管活性药物支持的需求增加（p = 0.045），重症监护病房住院时间和住院时间延长（均为p < 0.001）。倾向得分匹配后的多变量逻辑回归分析显示，淋巴细胞减少对死亡率有显著影响，比值比为1621（95%置信区间：1275 - 2048；p < 0.001）。交互模型显示，伴有淋巴细胞减少的患者每增加十岁，死亡率增加8%。在利用三组分层的亚分析中，严重淋巴细胞减少组的死亡率最高，不仅在直接比较中如此，在Kaplan-Meier生存分析中也是如此（对数秩检验p = 0.0048）。
COVID-19患者的淋巴细胞减少与疾病严重程度增加和死亡风险增加相关，强调了对重症高危患者及时给予支持的必要性。这些发现为改进COVID-19患者的护理策略提供了重要见解。
